With increased survival rates for low birth weight infants, the focus of pre-term follow-up studies has shifted to gain a better understanding of the scope and nature of perinatal morbidity. The purpose of this project is to investigate the relationship between prematurity and preschool motor and functional performance in two cohorts categorized by similar perinatal risk and born ten years apart. Motor ability is evaluated in four specific areas: general motor, gross motor, fine motor, and visual motor integration. Functional performance evaluates the consistent ability to perform the tasks of daily living and expected social roles. The setting is the major regional source of care for high-risk infants and has achieved the highest ratings when compared to others in survival, length of stay and quality of outcome. Data for Cohort 1, born between 1985 to 89, were collected as part of a study of 188 full term and pre-term children who were studied longitudinally from birth to age 8. This sample showed substantial delays in motor function at age 4, which are associated with dimensions of poor school performance at age 8. This application requests resources to recruit and conduct complete motor and functional performance assessment of a later cohort at age 4, Cohort 2, born in 1996 to 97 and identically stratified by perinatal risk. Given the increased fragility, lower birthweight and younger gestational ages of Cohort 2, it is hypothesized that there will be a decline in motor and functional performance between decades. There are two specific aims. Aim 1 investigates the effects of perinatal risk on motor and functional performance in two samples of NICU survivors stratified as: 1) healthy full term group; 2) pre-term/medically ill group; and 3) pre-term/neurologically ill group. Aim 2 compares the motor and functional performance of the two stratified samples. This application is unique in that it affords the opportunity to provide critical information about motor sequelae resulting from new neonatal advances, as well as replicate potentially deleterious outcomes found in the children of the earlier cohort. Cohort comparison results are crucial in terms of understanding the full range of pre-term motor sequelae within a time frame of advanced neonatal technology.